syringomyelia????

Re: syringomyelia????

Sarah Keir — Sat, 03 Mar 2012 20:45:39 GMT

Thank you!

I'll file the information in my mental bank of neurology information. Take home message = make sure it is neurological!

Re: syringomyelia????

Mark Lowrie — Sat, 03 Mar 2012 20:29:25 GMT

I think the problem list feo the owner is ear/head scratching. The odd behaviour is very non-specific and is likely related to discomfort or pain. As illanit said, the high temperature is a common finding in this dog when at the vets therefore unlikely to be of significance. The first question a neurologist always asks is "is it neurological?" In this case I think it would be correct to rule-out all the non-neuro causes for head/ear pain. If this is truly neurological then I cannot think of any disease other than SM that would cause similar signs. Hope this helps. The late onset is not too unusual as SM has been shown to progress (on imaging at least). Therefore a normal young dog can develop signs of the disease.

Re: syringomyelia????

Sarah Keir — Sat, 03 Mar 2012 19:58:43 GMT

What would be your differentials for this case Mark?

Summary from what I can gather from this case - wall hugging but just poodle gait, sudden onset head/neck scratching, not himself/depression, possible pyrexia, external ear canals normal.

Please help us learn from this case !!!

Re: syringomyelia????

Mark Lowrie — Sat, 03 Mar 2012 17:25:41 GMT

Meningitis usually occurs in dogs less than 2 years and typically causes neck pain such that a dog has a low head carriage and stiffness when it moves. Judging by the way this dog is bouncing and it's age I would struggle to attribute these signs to meningitis. Claire is right that trialling treatment without diagnosis is a bad idea and whenever we see CKCS syringomyelia is almost a certain finding. Just as in the case you mention it is important to determine whether its presence is incidental or the cause of the clinical signs. Given SM can only be diagnosed with MRi, and as that is unavailable in this case, I think it is reasonable to trial gabapentin. I accept this is not the 'best' option.

Re: syringomyelia????

Mark Lowrie — Sat, 03 Mar 2012 17:24:31 GMT

Meningitis usually occurs in dogs

Re: syringomyelia????

Mark Lowrie — Sat, 03 Mar 2012 17:22:22 GMT

Meningitis usually occurs in dogs

Re: syringomyelia????

Mark Lowrie — Sat, 03 Mar 2012 17:20:32 GMT

Meningitis usually occurs in dogs

Re: syringomyelia????

ilanit — Sat, 03 Mar 2012 15:30:07 GMT

I guess I am looking for zebras here in stead of horses!

Nothing seems to fit the picture somehow though. External ear exam is fine, but dog is very bouncy so would need to sedate to be absolutely sure, which I haven't done yet. But from what I can see they are clean and no fb. Owner did not take him out the day it started very suddenly, so unlikely grass seed. There is no obvious neck pain and even pressing at the base of the ear seems ok. And as you can see the dog bounces happily up and down, but seems to make scratching movements after jumping. Skin looks perfect. No head tilt, so internal ear infection not so likely. I think the hypermetria is just 'normal poodle gait'.

My colleague started him on pred/baytril last 2 days and today possibly seemed a bit better so they opted to try baytril for a couple of days more. If no success I think I'll sedate to double check ears and maybe take an X-ray. If all not helpful might try the gabapentin.

Thanks!!!!!

Re: syringomyelia????

Sarah Keir — Sat, 03 Mar 2012 12:31:05 GMT

I recently referred a suspect SM to Clare Rushbridge and her advice was not to 'trial treament' for SM as an aid to diagnosis as many diseases would respond at least temporarily to them (frusemide, ACEi, gabapentin). But on the other hand she has a vested interest in getting things to be referred to her i.e. money from MRI. The cavalier I send did have SM but it was only incidently as she felt the itch was due to generalised pruritis (in a 7m old cavalier). Would somehting like meningitis respond to the pain-knumbing qualities of gabaopentin and cloud the diagnosis?

Sarah

Re: syringomyelia????

Mark Lowrie — Sat, 03 Mar 2012 11:21:03 GMT

I don't think there is enough on the video to guide a diagnosis. If this were SM, then dogs usually respond well to 10 to 20 mg/kg gabapentin TID. But I would be sure to rule-out dermatology issues first as SM is rare in this breed. Though it certainly is a possibility. If gabapentin doesn't work it's unlikely to be SM.

Re: syringomyelia????

Sarah Keir — Sat, 03 Mar 2012 11:05:01 GMT

Hi ilanit,

I'm not a neuro specialist - in fact I hate neurology with a vengence, probably because I don't understand it well, so I am forcing myself to look at neuro cases to get more experience.

My first thought would be meningitis, doesn't fit with what I know of syringomyelia. Wall hugging both sides, possibly hypermetric both front legs (though poodles have a very poncy gait), pyrexic, doesn't look ataxic from the video as jumping up and not falling over. The air scratching could just be from any source of pain in head/neck area and this would fit with depression/lethargy? Have you tested for neck pain or tested cranial nerves?The gut signs could well be completely seperate, in fact much more likely to be infammatory gut disease/'antibiotic response'. Hasn't got a head tilt or circling so I'm not thinking middle ear diease (and I guess the tympanic membrances looked normal on exam).

Any neurologists out there that can help?

Sarah